You are here

Politics. Change. Prevention.

Art Gonzalez, CEO of Hennepin County Medical Center, sees change on the horizon. More than just health insurance is getting an overhaul; the way hospitals will be graded on success is, too. In the second and final part of his interview with the Downtown Journal, he talks about what that means for HCMC right now and what it will mean down the road.

Downtown Journal: What’s your sense of state leaders’ views of HCMC?

Gonzalez: I get the impression that we’re well known and well regarded. They recognize the impact that we provide in the region.

Obviously, the farther you get into out-state Minnesota, the more they worry about rural issues and access to care and what they have going on out there. So there’s this natural tension, you know, that they want to keep as much of the money where they are, and this area wants to keep it here. But it’s a healthy tension, and it’s OK.

Not everyone thinks the same way. That’s the nature of politics. But I think they regard us pretty well.

Probably the most recent profound example was the state’s bonding bill. One of the things that Hennepin put on the table was the rebuilding of the hyperbaric oxygen center, an almost $10 million project. We were asking for $5 million, and $5 million out of a limited pool of money is a lot to be asking for. … But when it all came through, the Legislature granted the $5 million. Then it went to the governor, and he approved it as well.

I think that proves that even when times are tough and money is tight, they recognize the unique things that we provide, that if it were not provided here in Hennepin, you’d have to go to Milwaukee or Iowa or something like that.

That’s an example of good news, but you’ve seen your share of bad news here, too. How do you deal with that?

You have to have an even temperament. You can’t get overly excited every time something goes bad.

The way I describe it is that, if you wanted to be a surgeon but you faint at the sight of blood, you wouldn’t be a very good surgeon. It’s sort of the same thing here.

You have to be able to get good news without getting carried away, and you have be able to get bad news without getting carried away. You have to have plans, but you also have to have backup plans — and backup plans to the backup plans.

This is no disrespect to my private colleagues, but at a private hospital I used to have to think about steps one, two and three. At a public setting, you have to think about steps eight and nine, because it’s that tight and it’s that complex.

DTJ: Where do priorities fall when big cuts come down the pike?

Well, you have your plans. But then you have to be open to the fact that your plans may not work out. I have a calendar that says every day what I’m going to do, and although I hardly ever do everything it says, I still have it on my calendar. It helps me prioritize.

So that’s why it’s important not only to plan the resources we need for what we’re doing but also to have reserves — modest reserves — built up for rainy days. And to think about what we’re going to do if this doesn’t work out.

For example, when we plan a program, we plan not only what we do, but we also plan an exit strategy. Another thing we’re doing is based on a service matrix. … There are some things that are or are not medically needed, and then there are things that are self-sustaining and not self-sustaining. If it’s self-sustaining but not medically needed, you have to evaluate that against next best alternatives. … For example, you could go into the cosmetic surgery business, but is it medically needed? Probably not. …

For a safety net hospital, this is where most of our things are: Doesn’t make a lot of money, because we have a large contingent of people who can’t pay, but medically needed. The population needs it; the area needs it. Burn centers, for example — they lose money. But if we weren’t here, where would you go if you had a burn?

What about growth? Are there things HCMC can do to expand in this economy?

I think it’s time for HCMC to grow responsibly. By that, I mean we have to be very judicious and very careful.

I think the areas in which HCMC is growing right now is the right spot to grow in right now. It’s where federal health reform is taking us, into preventative care, ambulatory care, medical homes and other kinds of care models. …

We’re also looking at revamping our Downtown clinic space because right now, we have tremendous outpatient work going on but it’s being done in an in-patient setting. So it doesn’t have a clear identity, and it’s not convenient for the patients and it’s not convenient for the physicians and care providers. So we really need to put up a center that’s designed for ambulatory care. …

There are some renovations in our units that we need to do. Our youngest building is 30-something years old, and some of our oldest are closer to 70, 80 years old. So it’s not only the physical space that needs work, it’s the infrastructure behind that space. The heating, the electricity, the plumbing and stuff like that. ...

Not even if finances were in better shape?

We’d have to evaluate.

The measure of success in the ’70s and ’80s was expansion. Growth and bigger buildings, more beds — that kind of thing. Now what we’re trying to do is say we’re actually more successful as a health field if we keep people from getting diseased rather than treating them after they’ve gotten sick. Keep them healthy and educate them appropriately about nutrition and health habits and health behaviors. Access to health facilities is an important piece, but it’s not the only piece. It’s probably not even the most important piece.

Where do you see health care policy headed?

I think the biggest driver is at the federal level. That’s where the majority of the money is, and they kind of drive how much goes to the states or how much is to come from the states. We’ll try to model ourselves after what comes from them.

So much focus seems to be on insurance.

It’s interesting — when people talk about health reform and they get to the insurance piece, that has nothing to do with health. It has to do with payment reform.

I won’t say that that’s not important, but that’s not the main thing we do. The main thing for us is what’s the money — whether it’s coming from an insurance company or from the government — what’s the money paying you to do? If the money is paying you to do more, then guess what, people do more. More surgeries, more admissions, more tests.

But if the money says, “No, we’re going to pay you for keeping healthy, and these are the measures by which we determine that you’re well and healthy and cared for,” then doing more won’t get you rewarded.

Our health care system, it’s made up of three components: One is that the system does what it was designed to do or what it is incentivized to do. That has to be fixed.

No. 2, the institutions that respond to those payments systems need to modify their approach and base it more on keeping people well.

But No. 3, there’s also personal responsibility. The World Health Organization says that 50 percent of your health status is due to your own health efforts and health behaviors. Twenty percent is due to genetics, and 20 percent is due to your environment. Only 10 percent has to do with access to health care facilities.

So if we want to improve health, building more hospitals doesn’t improve health. It just improves access to health facilities.

Let’s switch back for a second and talk about government funding. There was a ruckus earlier over potential cuts to General Assistance Medical Care. It sounded like HCMC was staring down some pretty bad news.

I think we’ve been a victim of our own success. What I mean by that is that we did a very good job of trying to — in a very short period of time — heighten the awareness of the community, the professional community, the business community, the general public and the Legislature about this being a very serious matter. Having done that, though, our goal wasn’t to say that we’re going under or that we’re drowning. It’s just very important stuff, and the Legislature needed to be careful with what they were doing.

We’re kind of turning now to [a fundraising gala] to say there is much more joy here than sorrow. There are babies being born, there’s cancer being diagnosed and treated, and there are patients being helped. …

In other words, HCMC will be around in five to 10 years and beyond.

Yes. It’s so well supported.

It’s just that it’s a living organism. You know, our human bodies are integrated systems that work just fine when everything’s going well, but if you do something unwittingly, you can all of a sudden shut the whole system down. It’s the same here.

—

About “Faces of HCMC”

Hennepin County Medical Center (HCMC) is one of the nation’s premier trauma centers and serves more poor patients than any other hospital in the state. We spent several weeks inside the hospital earlier this year, observing caregivers working in a variety of specialties. We got a firsthand look at life in the emergency room, took a ride with paramedics, checked out the hyperbaric chamber, visited expecting mothers in the midwife unit and toured many other areas in HCMC.

In our Aug. 16–29 edition, we featured stories on HCMC paramedics, the Cardiac Catheterization lab and hyperbaric chamber.

If you have stories to share about HCMC or feedback on the project, comment on our Facebook page at facebook.com/DTjournal.

Art Gonzalez, CEO of Hennepin County Medical Center, sees change on the horizon. More than just health insurance is getting an overhaul; the way hospitals will be graded on success is, too. In the second and final part of his interview with the Downtown Journal, he talks about what that means for HCMC right now and what it will mean down the road.

Downtown Journal: What’s your sense of state leaders’ views of HCMC?

Gonzalez: I get the impression that we’re well known and well regarded. They recognize the impact that we provide in the region.

Obviously, the farther you get into out-state Minnesota, the more they worry about rural issues and access to care and what they have going on out there. So there’s this natural tension, you know, that they want to keep as much of the money where they are, and this area wants to keep it here. But it’s a healthy tension, and it’s OK.

Not everyone thinks the same way. That’s the nature of politics. But I think they regard us pretty well.

Probably the most recent profound example was the state’s bonding bill. One of the things that Hennepin put on the table was the rebuilding of the hyperbaric oxygen center, an almost $10 million project. We were asking for $5 million, and $5 million out of a limited pool of money is a lot to be asking for. … But when it all came through, the Legislature granted the $5 million. Then it went to the governor, and he approved it as well.

I think that proves that even when times are tough and money is tight, they recognize the unique things that we provide, that if it were not provided here in Hennepin, you’d have to go to Milwaukee or Iowa or something like that.

That’s an example of good news, but you’ve seen your share of bad news here, too. How do you deal with that?

You have to have an even temperament. You can’t get overly excited every time something goes bad.

The way I describe it is that, if you wanted to be a surgeon but you faint at the sight of blood, you wouldn’t be a very good surgeon. It’s sort of the same thing here.

You have to be able to get good news without getting carried away, and you have be able to get bad news without getting carried away. You have to have plans, but you also have to have backup plans — and backup plans to the backup plans.

This is no disrespect to my private colleagues, but at a private hospital I used to have to think about steps one, two and three. At a public setting, you have to think about steps eight and nine, because it’s that tight and it’s that complex.

DTJ: Where do priorities fall when big cuts come down the pike?

Well, you have your plans. But then you have to be open to the fact that your plans may not work out. I have a calendar that says every day what I’m going to do, and although I hardly ever do everything it says, I still have it on my calendar. It helps me prioritize.

So that’s why it’s important not only to plan the resources we need for what we’re doing but also to have reserves — modest reserves — built up for rainy days. And to think about what we’re going to do if this doesn’t work out.

For example, when we plan a program, we plan not only what we do, but we also plan an exit strategy. Another thing we’re doing is based on a service matrix. … There are some things that are or are not medically needed, and then there are things that are self-sustaining and not self-sustaining. If it’s self-sustaining but not medically needed, you have to evaluate that against next best alternatives. … For example, you could go into the cosmetic surgery business, but is it medically needed? Probably not. …

For a safety net hospital, this is where most of our things are: Doesn’t make a lot of money, because we have a large contingent of people who can’t pay, but medically needed. The population needs it; the area needs it. Burn centers, for example — they lose money. But if we weren’t here, where would you go if you had a burn?

What about growth? Are there things HCMC can do to expand in this economy?

I think it’s time for HCMC to grow responsibly. By that, I mean we have to be very judicious and very careful.

I think the areas in which HCMC is growing right now is the right spot to grow in right now. It’s where federal health reform is taking us, into preventative care, ambulatory care, medical homes and other kinds of care models. …

We’re also looking at revamping our Downtown clinic space because right now, we have tremendous outpatient work going on but it’s being done in an in-patient setting. So it doesn’t have a clear identity, and it’s not convenient for the patients and it’s not convenient for the physicians and care providers. So we really need to put up a center that’s designed for ambulatory care. …

There are some renovations in our units that we need to do. Our youngest building is 30-something years old, and some of our oldest are closer to 70, 80 years old. So it’s not only the physical space that needs work, it’s the infrastructure behind that space. The heating, the electricity, the plumbing and stuff like that. ...

Not even if finances were in better shape?

We’d have to evaluate.

The measure of success in the ’70s and ’80s was expansion. Growth and bigger buildings, more beds — that kind of thing. Now what we’re trying to do is say we’re actually more successful as a health field if we keep people from getting diseased rather than treating them after they’ve gotten sick. Keep them healthy and educate them appropriately about nutrition and health habits and health behaviors. Access to health facilities is an important piece, but it’s not the only piece. It’s probably not even the most important piece.

Where do you see health care policy headed?

I think the biggest driver is at the federal level. That’s where the majority of the money is, and they kind of drive how much goes to the states or how much is to come from the states. We’ll try to model ourselves after what comes from them.

So much focus seems to be on insurance.

It’s interesting — when people talk about health reform and they get to the insurance piece, that has nothing to do with health. It has to do with payment reform.

I won’t say that that’s not important, but that’s not the main thing we do. The main thing for us is what’s the money — whether it’s coming from an insurance company or from the government — what’s the money paying you to do? If the money is paying you to do more, then guess what, people do more. More surgeries, more admissions, more tests.

But if the money says, “No, we’re going to pay you for keeping healthy, and these are the measures by which we determine that you’re well and healthy and cared for,” then doing more won’t get you rewarded.

Our health care system, it’s made up of three components: One is that the system does what it was designed to do or what it is incentivized to do. That has to be fixed.

No. 2, the institutions that respond to those payments systems need to modify their approach and base it more on keeping people well.

But No. 3, there’s also personal responsibility. The World Health Organization says that 50 percent of your health status is due to your own health efforts and health behaviors. Twenty percent is due to genetics, and 20 percent is due to your environment. Only 10 percent has to do with access to health care facilities.

So if we want to improve health, building more hospitals doesn’t improve health. It just improves access to health facilities.

Let’s switch back for a second and talk about government funding. There was a ruckus earlier over potential cuts to General Assistance Medical Care. It sounded like HCMC was staring down some pretty bad news.

I think we’ve been a victim of our own success. What I mean by that is that we did a very good job of trying to — in a very short period of time — heighten the awareness of the community, the professional community, the business community, the general public and the Legislature about this being a very serious matter. Having done that, though, our goal wasn’t to say that we’re going under or that we’re drowning. It’s just very important stuff, and the Legislature needed to be careful with what they were doing.

We’re kind of turning now to [a fundraising gala] to say there is much more joy here than sorrow. There are babies being born, there’s cancer being diagnosed and treated, and there are patients being helped. …

In other words, HCMC will be around in five to 10 years and beyond.

Yes. It’s so well supported.

It’s just that it’s a living organism. You know, our human bodies are integrated systems that work just fine when everything’s going well, but if you do something unwittingly, you can all of a sudden shut the whole system down. It’s the same here.

—

About “Faces of HCMC”

Hennepin County Medical Center (HCMC) is one of the nation’s premier trauma centers and serves more poor patients than any other hospital in the state. We spent several weeks inside the hospital earlier this year, observing caregivers working in a variety of specialties. We got a firsthand look at life in the emergency room, took a ride with paramedics, checked out the hyperbaric chamber, visited expecting mothers in the midwife unit and toured many other areas in HCMC.

In our Aug. 16–29 edition, we featured stories on HCMC paramedics, the Cardiac Catheterization lab and hyperbaric chamber.

If you have stories to share about HCMC or feedback on the project, comment on our Facebook page at facebook.com/DTjournal.